| NPI | 1346964756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 026037) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 118136-01) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2023-10-09 |